STUT'l'ERIFG A PSYCHOLOGICAL PHENO!.\ENON .

KATHERINE HO GAIK CHOO

NO . hlATRIK 0501 33

LATIHAN IIJllIAII

DAGI MEMENUHI SEDAIIAGIAN

DAHIPADA SYARAT- S1Al1AT UIJTUl~

IJAiAJI JAHJJU~A MUDfl SASTEHA .

( AL 390)

- JADATAN ANTROEOLOGI DAN SOSIOLOGI

UNIVE1WI'rI MALAYA

h.UALA LUMPUR

SE.J~I 1988

Univers

ity of

Mala

ya

Stutt,ring : A Psychological Phenomenon

Lo.tihan ilmiah so.yo. mempersemb::i.hkan masa.lah ' Stuttering•· yang dihadapi oleh sebilangan daripada seti ap m.asyar akat . lfebolehan bcrcalcap a.dalah sangat penting supaya terdapat komunikasi antara. ahli- ahli sebuah masyarakat , dan ' ..>tuttering' menGha.lang komunikasi yang cekap .

Oleh kerana ' stutterin~' tidak dapat diterangkan ol eh so.ins perubata.n , so.ins ps i kologi tclah mencuba untuk

mcwujudlcan tcori-teori untuk memo.ho.mi fenomena ini .

::>aya tela.h memberilco.n hujah- hu j ah dua teori akan fenomena

· ~tuttcrinG ' berserta dengan definasi yang diQ.lilakan oleh

pa.kar- po.lcar l'ercukapa.n .

Porto.mo. ial~1 ' AnLi ciputory Ut1~eclo Theory ' yane cuba melilw:t ' 0tutterine ' so bo.Gai sn. tu lee sun pcnc;alama.n yang lopa.o yo.nJ buruk tcnt:.iut; pcrc::iknpo.n . Olch itu ooocorang a.lean menjuni:;lcn ia altun borl::iltu :.H.iknli l o.ci lnlu uoraaa tulru t o.kan si t.uusi yuni; srnna ui11m11a io. uknn bcrcclco.p

terhcnti- henti • •

Teori kcdua i ulcl1 aa. t.u tcori konfllk yo.ne moliho.t

' :..;tut t erine' s c bO.CTO.i clua kcmuhua.n yune bcrt cnt a.n[pn .

Kcduo.- duo. lccmo.hu :.m , un t.u unLulc l>crcuku.p dun ~atu l aBi

untuk di am snhaja tlidorone olcll tokanan- teknnan dalaman

clan luaran .

Akhirnya kedua- dun. teori ini dinilaikan dari ser;i

kebolehannya untuk dikaj i dan <.libulctikan berdasarkan tlun. pengka jian yanr; dilakukan keatu.s ' stut terers '

di Amerika Syarikat .

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CONTENTS

Fotr.ewotr.d

Introduction 3

I. DEFINITION OF STUTTERING 6

I I. HISTORY OF THE THEORY OF STUTTERING 18

III . TWO THEORIES OF STUTTER ING

( i ) Anticipatory Strugg le Theory 24

( i i ) Conflict Theo ry 31

IV . RELATING RESEARCH TO THEORY 37

Appendi xes

Bibliography

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Fo11.e.wo11.d

Stuttering and the theories formed thus far to exp lain its possible

origi n cannot be said to be conclusive . Therefore it is not the

intention of thi s resea rch paper to do what massive researches have

tried and fai l ed .

Instead I will attempt to discuss this parti cul ar disorder of speech in

rel ation to the psychological approach used in current theories , and

how these theories are s ignificant to a child' s acquisition of

language .

Researches have shown more than half the children who stutte r develop

t his speech phenomenon during the pre- schoo 1 yea rs of their childhood.

However I have made a general rather thdn a spec ifi c overvi ew because

stuttering is a traumatic and recu r ring speec h problem fo r both the

child and the adult.

Despite our modern sophistication in communication techniques , society

is sti l l cruel to those who fa il to impress her wi th a f luency in

speech and language , often s i gnifying a hi gher stat us symbo l.

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Introduction

Laura was 30 years old . She was a college graduate trained as an

occupational therapist . Her husband was a young successful attorney

and she had t hree children aged eight, five and two.

Before her marriage she had worked for a short time on an assembly line

in a factory and as a waitress while in college . She had appli ed for a

job as an occupationa l therapi st only once and was turned down, she

felt, because of her speech . She never aga in applied for such a

position .

She had an open and ready smi le fo r her children and husband but two

years before , soon after the birth of her third chi ld, she had become

extreme ly depressed and attempted to commit suicide . Her psychi atric

therapy was brief . Laura attributed her depress ion in part to having a

very severe pro bl em of s t u tteri ng.

She open ly cried when reca lling how , in her childhood, her parents had

forbidden her to talk when guest were in the home . Her embarrassment

and sadness and anger over these thoughts overwhel med her. Wherever

she went she carried little index cards on which she had written out

brief messages as substitutes for oral communi cat ion , in case she

needed info rmation, was lost , or was in an emergency situation t hat

required communication. On one occasion she had wandered around fo r

30 minu tes trying to l ocate a gate and fligh t in an airport , without

talking or as~ing for help.

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She had finally fo und her destination in silence .

She tearfu l ly stated that because she stuttered , she cou l d never say

"t hank you" to people , who as a res ult thought she was rude , al oof or

ungrateful . She never used the phone , depended on her husband for

ta lking, shopp ing and so on . She constant ly stayed at her husband' s

si de during soc ial out ings .

She felt she was a failu re as the wife of a professional man and as a

mother . She had been in and out of therapy for 25 years and al though

he r hopes for help had been dashed many times , and she carried the

scars of many years of di sappointment and futi l ity, she was still more

hopeful than sceptica l . 1

In my own preliminary research , I found many pnrents in Malaysia

re l uctant to acknowl edge Lhal their child had a sµccch problem . Those

\'lho can afford it , send t hei r child ren to the 0 11 ly 2 or 3 private

t herapists in the country. Even t his is true on ly in cases where

parents recognise it as a probl em t hat can be he l ped and are not

ashamed to acknowledge the defi ciency . One parent I spoke to at a

private clinic sa id they never had guest s at thei r house and never

allowed their son to mix with other ' normal 1 chi ldren. Protectiveness

of this nature can be very harmful t o the devel opment of the child .

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Note

1

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A summary of a case report quoted in George H. Shames , "Disorders

of Fluency", in Human Communication Disorders , eds . , George

H.Shames and Elizabeth H.Wiig , (Columbus, Ohio : Charles E.Merill

Publishing Company, 1986) , pp . 243 - 244 .

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DEFINITION OF STUTTERING

Most clinic ians in the field of speech pathology , today, make a

distinction between speech disorders and language disorders. This

basic division leads to subsequent classifications that are at once

varied and difficult to distinguish even for the experts . Fortunately

we are only interested in one classification, stuttering, which is

considered " the great white whale of speech disorders••. 1

Such maybe an exaggeration but it underlies the basic problem of any

attempt to study it. Stuttering ca n occur in any age group or social

context . Most of the time it cannot be attributed to any singl e root

ca use or even a group of ca uses . If one cdnnot determine the origin of

the problem how does one cure it? Even before we enter into the

probl em of therapy t here is the prob lem of definition . Who decides a

speaker is stuttering ? How docs thi s person distinguish between

stuttering and other speech di sfluencics? Perhaps the speaker is

merely ex peri encing a normal disfluent manner of speaking.

One definition offered to describe stuttering is 11 a neuromuscular

dysfunction , always associated with neurotic manifestations , and with

anxiety always present" .2 I will not even attempt to decipher such a

definition offered in 1943 , a time when interest in stuttering had just

begun but l ittle was kn own about it .

In stead I will use the more simpl e and often used definition of the

prol> 1 Nn.

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"Stuttering occurs when the forward fl ow of speech is interrupted

abnormally by repetit i ons or prolongations of a sound or syllable, or

articulatory posture or by avoidance or strugg le reactions 11•3

Now one should ask what is an 'abnormal interruption' . Research data

has shown conclusively that stutters have more syllabic repetitions per

100 words and more of them per word than normal speakers .4 They also

have more sound prolongations.

A norma l speaker rarely has to repeat a syllable and when he does he

uses the correct vowel and repeats it at the regular tempo of his other

syllabl es , eg. "Sa-Saturday" .

By comparison the stutterer tends to say, 11 Suh-Su h-Sih-Suh-Seh-Sa-Saturday 11•

Al so a normal speaker tends to repeat words and phrases , not syllables

and sounds.

The term "posture" is used in this definition to indicate that not all

repetitions and prolongat ions are vocalized . The stutterer may be

mak ing several silent mouth postures, before a word is spoken . He may

even assume a fixed position and struggle si l ently before blurting out

what he wants to say . He could be hold ing his breath , protruding his

tongue or twisting his li ps to one side . Al l of which are considered

as articulatory postures which break up the normal sequence of speech.

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Avoidance and struggle is used to describe the visual rather than the

inner difficulty that can be seen when a person stutters . However

avoidance and struggle result from a more complex conflict within the

stutterer which has lai d foundation to the theories that will be

di scussed later. At this point a description of these reactions would

be more useful.

For example , when someone stutters he may protrude his lips gross ly,

make sucking and clicking noises and suddenly throw back his head

before his utters the word. Sometimes there are no facial contortions

but instead stuttering moments are marked by sudden gasps. These can

be so deep his shou lders jerk upward . There are also stutterers who

show very little of this overt struggle by dodging speaking situations

or saying feared words \'lhi ch t hey normally stutter in. They pret<'nd to

be thinking or interject "ah" or "um" or "well" to postpone the

expected misery . They become very skillfu l in these avoidance tricks

by scanning and planning , in order to anticiµate eve ry eventuality . 5

Another popular definition used by cl ini cians di vides stuttering into

primary and secondary. This class ification is indicative of the

awareness of the stutterer in order to plan for an appropriate program

for therapy.

"Primary stuttering consists of repetitions , hesitations and

prolongations in speech which occur without apparent awareness and

anxiety and without evidence of strugg le on t he part of the speaker11•6

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When there is no self-awareness avoidance or struggle of his

disfluency , the term "primary stuttering" applies . It occurs

especially in conditions where a disfluent child is placed in speaking

situations with fluent children , and colllllits speech abnormalities

automaticall y and frequently enough to interfere with communication .

But when the speaker becomes aware of his non- fluencies and attempts to

modify or avoid them stuttering is said to be secondary . "Secondary

stuttering'' includes t he added problem of the stutterer ' s reaction to

himse l f as a person and to the act of communi cation in general. While

all stutterers are relatively free from difficulty in some situations

this increased and constant self-awareness during communication can

resu l t in cases like Laura's, where one decides to live a life

constantly fearful of one ' s own suffi c iency .7

Search For A Stutterer's Profile.

One interesting result of the problem of s tuttering is how many early

researches, especially those conducted by students in Britain and

Ameri ca have tried to find common physical and psychological traits in

stutte rers. Proponents of "bio logically inherited background" and

those who believe it to be "a matter of tradition rather than genes 118

have presented hypothesis on the relati on of intelligence, home

influences, social learning, cultural background and psychological

traits to the phenomenon of stuttering .

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One such research found the mean intelligence quotient of 166

stutterers to be slightly above 99 .9 Some studies claim stutterers

test higher upon entering college than other freshmen . Parents who are

overprotective and pamper their children, and who are described as

over-anxious and excessively perfectionist is also said to have a

significantly higher incident of stuttering children . Personality

traits such as anxiety, undue sensitivity and embarrassment, fears and

depress ions have been claimed to be characteristic of mature

stutterers . lO

But for every such finding there are similar ones to prove otherwise.

So, instead of drawing a stutterer's profile, I would like to list here

a few of t he facts and not interpretations of the re search that has

been going for more than half a century in much of the Western nations .

These 'tru t hs ' about stutteri ng is followed by some Do ' s and Do Not' s

meant for those of you who might encounter child stutterers in your

circle of family or friends.

Facts To Know About 'Stuttering' .

There are more boys than girls among stutterers . The ratio is

about t hree boys for each gi rl.

Stuttering tends to run i n fami l ies . Fami l ies that include a

s tuttering child are more likely to have relatives who stutter

than famili es without a stutter ing ch il d.

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Families with twins are more likely to include a stutterer than

are families in which all children are singletons.

Stutterers are likely to be somewhat slower in beginning to talk

than non-stuttering children .

Stuttering is almost always a problem of early childhood , as it

usually begins between three and nine years of age . Only rarely

does a child begin to stutter in the adolescent years who has not

been a stutterer, for however brief a time , between the ages of

two and ten . In fact , onset after age ten is notably rare.

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DOs

* Establish as tranqu il a home environment as you can achieve

without suppressing other members of the family . Try to avoid or

reduce the need for speaking in situat ions that have heightened

exc itement or produce frustration (as in some games) . Children

need to learn to live wi t h and accept occas ional frustration. But

they do not need to talk during or immediately after experi encing

it.

* Listen to your child with full attenti on and patience .

* Speak to your chi ld in a calm, unhurried manner . However, do not

slow down so much as to be "dragging out your words" or with an

absence o normal rhythm. Occasionally , your speech shou ld incl ude

an easy , bouncy repetition, if on ly to demonstrate that anyone ,

even a parent , sometimes indulges in hesitat ion behavior .

* Keep your child in the best possibl e physica l condition .

Illnesses are likely t o bring on an increase i n hesitation

behavior . Expect t his and accept it if it happens . Univ

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Expect that your child, like many adults , may have a greater urge

to speak than to say anything in particular .

If your child starts someth ing he or she cannot f inish, smile

pleasantly and take the child off the hook . One way is to ask an

easy question or make an observation to which the child can

readily respond . The question or observation should have some

relati on to the situation the ch ild is talking about , however, and

t hi s may require a bit of creative thinking . Your ques tion or

observation may refer to an earlier part of the conversation .

* If your child appears to be groping for a word, or for a "tu rn of

phrase" to complete a statement , wait a decent time for the word

*

or phrase to come .

t he work or phrase .

If it does not , calmly and casually provide

I f at all possible, do so by using the word

or phrase in a sta tement or question of your own.

This technique has the added benefit of providing a

comp lete-sentence grammat ical model that your child may imitate .

With practice , the child may even make it part of habitual speech

behavior . But remember that children (and adults, too , for that

matter} , are likely to be most dysfluent when learning and trying

out new words and new verba l constructions .

Although you should casua l ly provide a word or phrase when your

child needs it , don't be in a hurry to j ump in and obviously

compl ete; your child' s thought . Give t he chil d 11 chancr .

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*

*

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Do all you can to make speaking p 1easurab1 e. Engage in "party

ta lk" , but talk as an adult. Don't talk down to the child. Tell

short, amus i ng anecdotes and play riddles, especially ones the

chil d can guess correctly . Read to your child , especially at time

when you have noted that your chi ld is likely to speak with

increased hesitation behav ior. Your child will learn that t here

is pleasure in listening as well as talking .

If your child asks whe ther there is anything wrong wi th the way he

or she speaks , or demands to know , "Why can 1 t I speak ri ght? 11

assure the chil d that he or she is spea king 11 right 11• If the child

insists that "sometimes my words don't want to come out , 11 exp lai n

that you know and that t hi s happens to you , too. It happens to

everyone . Do not go into long explanations , however, that reveal

your anxiety . Most children can easi l y tell when their parents

are \-Jorried about something .

* If you need help in understanding or fol l owing these directives ,

consult a competent speech or language clinician in your

community . Be sure t hat the person you consult is qualified and

competent.

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DO NOT's

*

*

*

Do not use the word stuttering or stalllllering or any equ ivalent

about your child's speech . If the chi ld does hea r such a word , he

or she will want to know what it means - and somehow will figure

out , no matter what you say , t hat it is not good to be stutterer .

Do not tell your chi ld to slow down , to stop and think before

speaking, or to "start over again and do it right this time" . Nor

should you say or do anything that will make your child feel or

suspect that there is anything wrong with how he or she talks.

Do not look at your child anxiously, afraid that the word flow may

not meet your hopes for flue ncy. Nei ther should you sigh in

relief when the child somehow does manage to speuk without the

usual hesitations .

* Do not ask the child to speak if he or she prefers to engage in

some other activity . If you make a men ta 1 note , or a written

note , about situations t hat are associated with an increase in

hesitation behavior , you can avo id asking or expecting your child

to speak in such situat ions .

* Do not discourage t he child from speaking on any occas i on when t he

child wishes to talk. If you can, however, "control" the overall

environment so t hat t he chi ld will not fee l a need to talk in the

situation ~ where, as you ha ve noted , he or she i s likely to br

excessively hcs1tant or repetitlou~.

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Not'lh

1

2

3

4

5

6

7

8

9

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Oliver Bloodstein , Foreword, The Problem of Stuttering by R.W .

Ri eber , ed. (New York: Elsivier North -Holland Inc., 1977) .

J .L. Despert as quoted in Muriel E.Morley, The Development And

Di so rders Of Speech In Childhood, (London : E & S Livingstone

Ltd., 1965) p.363 .

Charles Van Riper , Speech Correction : Principles and Methods , 5th

ed . (New Jersey : Prenti ce Hall Inc. , 1972) p.249.

Van Riper, p. 250.

Van Riper , p. ?51 .

M.F .Berry and J . Eisenso11 , Speech Disorders , (London

Ltd . , 1964) p. 249 .

Berry, P. 250 .

W.Johnson as quoted in M.F.Berry, p.252.

Be rry, p.253 , n.10.

Peter Owen

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10

11

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Berry, p.253.

Jon Eisenson, Is Your Child's Speech Normal? (Canada Addison -

Wes l ey Publishing Co., 1977) pp.95- 105.

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HISTORY OF THE PROBLEM OF STUTTERING

Stuttering was first mentioned by Hippocrates (460-377 B.C . ) as

11 trauloi 11, although this term probably refers to several speech defects

as a who le. Subsequent mention of it in the books of Epidemics are

quite obscure. This however did not stop Galen (131 - ca 200 A.O.)

from trying to make sense of it in his commentaries. 1

As I have mentioned earlier there wa s no definitive distinction made

between stuttering, cluttering , disarthia, functional articulation

probl ems and even some types of aphasia . At least not until the 20th

century.

Instead \'le get terms such as 'traulosi s ', ' pselli smos ', ' blaesitas'

etc . . . which describe the conditions rather than class ify the dcfcct s .2

In medieval medi cine , mind and body were inseparable , so the cause of

stuttering was traced to a person's supposed humoral system . The

ancient view believed there exist four qualit i es in the entire

universe; heat, cold , moisture and dryness. When combined in parts ,

heat and dryness produce fi re , heat and moisture produce air , cold and

dryness produce earth, and , co l d and moisture produce water. These are

the four elements in the human organism as in the universe , because man

is a microcosm of the other .

•

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In the human organism these four elements are the four humors , ye ll ow

bile, blood , black bile and phlegm. They are responsible for the

conditions that affect a man's mind and body . In every individual ,

there is the natural temperament, depending on which is the

predominating humor (see Fi g.1). 3

ELEMENTS

Air

Earth

Fire

Water

PROPERT IES HUMORS

Warm & Moist Blood

(spleen)

Cold & Dry Black Bile

TEMPERAMENTS

Sanguine

(hopefu l)

Melancholic

(spleen) (sad)

Warm & Dry Ye 11 ow Bi 1 e

(liver)

Cold & Moist Phlegm

Choleric

(erasible)

Phlegmati c

(brain & Lung) (apathetic)

Fig.l

Speech defects, like stuttering, was attributed to a humoral imba l ance

and knowledge of the natura l temperament of each pati ent was a

pre-requisite for t reatment . Stuttering in a phl egmat ic ' was believed

to have an entirely different aetiology from stuttering in a cho l eric

person. 4

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In the eighteenth century , the focus on scientific methods created one

of the f irst classification systems of communication disorders.

Boissier de Sauwages (1768) identifi ed clinical ent ities and listed

them according to simi l arities . Subsequently other class i f i cation

systems were developed such as Erasmus Darwi n' s discuss ion of speech

disorders which dealt with stuttering as a psychological prob lem . As

such, it deserved a psychophysiological analysis. Giovanni Battista

Morgagni {1682-1771) fol l owed a system stressing the patho l ogical state

of the organism. He concluded that deviations in the hyoid bone were

the cause of the majority of cases of stuttering .5

Another group know as 11associationists 11 such as David Hartley believed

that we arrive at an understanding of one another through the power of

association. Interpreted in a simil ar fashion, stuttering was sai d to

develop from fear , eagerness or violent passion that prevents the chi ld

from using hi s speech mechanism in t he correct manner .

Moses Mendelssohn (1783) , another such associationists postu l ated

another theory of stutteri ng . He felt that the occu rrence of emotions

and passions detrimenta l to the physiological order could result in

stuttering .

In the nineteenth century Jean Ma rc Gaspard Itard , a renowned French

physician formulated a t heory in which he attributed the major cause of

stuttering to a generalized deficiency in t he nerves . This in turn

would fail to stimulate proper innovation of the muscles of t he larynx

and tongue.

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The general shift of the century from universality to the individual

wa s a phi losophy which had an effect on the theories of stuttering ,

that were developed at that time . Edward Warren (1804-1878) the first

American to write a scientific paper on stuttering noted that there was

no organic defect of the physical speech organs in stutterers. He

pointed out t hat stuttering varied in individuals and sometimes

disappeared. He concluded that stuttering was a very complex disorder,

originating in childhood , and aggravated by fear and by the habitual

nature of the problem. He was interested in the personality of the

individual stutte rer and said that stutterers were usually of nervous

temperament , the cause being both mental and physical.

In 1841 Andrew Comstock also quoted psycholoqical reasons and the the

basic problem could be alleviated ii the peri pherdl mechanism could be

made to "obey the conmmnd of the will 11•6

In the twentieth century , the concept of debility in organs or

processes was exchanged fo t· debility in i nterna 1 systems such the

11endocrine, autonomic nervous, central nervous and metaboli c systems 11•7

The perennial concept of conflict was also to become an approach to may

theories of stuttering.

But the one important aspect of twentieth century theories is that it

has the advantage of research f i ndi ngs. Clinical and research date

could be used to derive or confirm a viewpoint. Stuttering became the

subject for much investigation and speculation . Hypothes i s were

formed, and oftcn .. cou ld be supported or refuted by thr nmssivr

r~~cc.1rches being performed .

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The aetiology of stuttering managed to present much that cou l d hel p to

a better understanding of the problem. At the same time , it has also

been said , "when scrut inized close ly, they [the theories of stutteri ng]

are more like myths than theories". This is because both theory and

myth are systems for providing explanation ot events and while they

make assertions about the real world, it cannot be proven in the

ultimate sense . Theories of stuttering thus far cannot prov i ded

substantive understanding . Like myths , they were designed simply fo r

expl anation .8

The fo llowing chapter contains three of t he more prominent t heori es of

stuttering and certa inl y the most recent that i s avail abl e for this

research paper. It is for you to dec ide how far is it a myth or a

theory of stut teri ng.

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No.tu

1

2

3

4

5

6

7

8

R.W.Rieber and Jeffrey Wallack, 11 The Historical Roots of the

Theory and Therapy of Stuttering, 11 in The Problem Of Stuttering ,

ed . R.W.Rieber (New York : El sev ier North-Holland , Inc 1977) p.3 .

These are Latin terms which no longer have clinica l entities in

our century . For further explanation of its uses, see R.W .Rieber,

ed ., Part II. "Historical Roots of Stut tering, 11 The Problem Of

Stuttering .

Rieber , pp . 4-7 .

An elaborate example of this renaissance approac h to speech

defects is found in "llieronymus Mercurialis, Treatise on the

Diseases of Children , Venice, 1583 (excerpted) 11 Rieber pp . 127-140 .

Throughout I fo l low the accou nt of the early theorists of

stuttering in The Problem Of Stuttering , ed., R.W.Rieber.

Rieber , p. 17 .

Rieber p. 19.

Marcel E.Wingate, 11 The Relationship of Theory to Therapy in

Stutter ing, 11 in The Problem Of Stuttering .

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TWO THEORIES OF STUTTERING

''Fifteen million of our fell ow throughout the world .• ... speak with

words whose wings are broken . As stutterers they are one of the very

largest contingents of the disadvantaged , and since first their

predicament was recorded by the ancients it has been held to be among,

the more baffling of mankind ' s many woes".

Wendell Johnson (1959)

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(i} Anticipatory Struggle Theory

This theory by Bloodstein says that stuttering is a struggle reaction

which reflects the speaker's moment of doubt about his ability to say a

word or other element of speech. In trying to develop an adequate

theory of stuttering he not only explains the moment of stuttering but

al so the aetio logy of the disorder . 1

The question to as k when tryi ng to understand the moment of stuttering

is why a stutterer who has spoken norma lly for so ma ny seconds , minutes

or l onger suddenl y repeats , prolongs or blocks on a sound again . Thi s

then i s the moment of stutte ring and to f rame it in conceptual thought

we say it i s a reaction of tension or fragmentation resulting from t he

threat of fai lure . StuLLcre rs behave as though t hey have acqu ired a

belief in the difficulty of speech, and a ppe~r to strugg le aga inst an

imagined obstac le in the process of articulation.

In any motor skill, i f the person believes it is important to carry it

off well , he tends to try too hard . He becomes tense and produces

muscl e t ens ion . If he believes the whole thing to be too difficult t o

do all at once , he may take the activity apart. He then carries out

the activity in fragments .

Unfortunately talking is one th ing that can be done well on ly wi thout

try ing. It is al so subject to cultural standards and soc ial scrut iny

whi ch makes it an activity li ab le to failure yet with cons iderab le

importance attached to it .

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In behavioral terms , the anticipatory struggle theory states that

stuttering is governed by stimuli . Based on past research data and

Bl oodste in's own laboratory tests, stutte rers were said to show a

consistency effect, Stuttering tended to occur on the same words; so

much so it became a predi ctable response to identifiable stimuli [the

particu lar words]. 2

However, the stimuli that functions for one does not necessarily

operate for another . The individual factor such as past experiences

with particular cues largely determines when the stutterer wil l

experience a block in speech.

One maxin1 of th i s theory is that stuttrri ng is due to anxiety about

speech 0 1· stuttering. W.Johnson (1959) felt t hat the more t he

stutterer fell anx ious about hi s situation the greater the struggle

will be to get the words out correct ly . Because Johnson's emphasis was

on anxiety as a function of stutte ring he li sted the facto rs

determining degree of anxiety in hi s theory . (see Fig . 2)3

Factors Dete rmining Degree Of Anxiety .

* Severity and discomfort of past stuttering.

* The penalties consequent to past stuttering.

* The stutterer ' s insight into the nature of his stutte ring

behavior.

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*

*

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The stu tterer ' s fami l iar i ty wi t h ways of modifying hi s

st uttering res ponses t o dec rease tension , discomfort and

feelings of helplessness and l ac k of control involved in

them.

Stu t t erer's own sense of personal securi ty, at being able to

stutter and hi s basic personal and social adj ust ment .

Fi g. 2

As one ca n see al t hough Bloodste in' s t heory does not emphasi ze anxiety

as an impor ta nt element , most of the ideas on anti cipati on and se l f

awareness has already been ex pounded by its predecessors like Jo hn son .

But instead anx iety is defi ned in terms of avoi dance reactions . Jn

ant ic ipating moments of stutter ing, speech avo ida nce reactions produce

t he very t hing stut te rers des pair of. Soc ial penal ties is said to make

stu tterers persi s tent ly anxious about t heir di sfluency. Fea r of

stu t t ering means mo re anti ci pati on of stut te ring whi ch becomes t he

basi s for stuttering aga in.

Si nce this hypothesis be l ieves t hat stutteri ng grows out of past

experi ences of speech failu re (like Johnson' s ) wh ich produces a bel ief

in it reoccurring, the search beg i ns fo r how one acquires thi s bel ief .

In dividing t he fa ctors i nto two broad ca t egori es , we get f irst the

immedi ate provocati ons for s t uttering and second the fact ors t hat

credtr· a general dtrnosphcre of comrnuni ct1 Li o11 prC'ss urc .4

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Delayed speech is the first of the i mmediate provocations for

stuttering. Children who are slow in developing speech and language

skills and are regarded by the parents and other as defective in

articulation, are apt to become intensely concerned about their speech .

They may then begin to f ind communication a struggle that requires

laborious preparations and special effort . Many of these children may

not even be experi encing delayed speech acquisition, parents and

relatives could be j ust over-demanding and impatient of infantile

errors .

Defective articulati on i s said to constitute the most common singl e

provocation to s tu t t ering. Parents often ass ume their children' s

ordinary defect s of arti cul at ion to be due t o carelessness , a "l azy

tongue" or excess ive rapi dity. Criti cism, bribery or commands makes

them fea rful of spea king and it becomes an acquired habit.

Among other provocati ons are reading difficulti es and cluttering and

those that are non-psyc hol ogi cal like aphas ia , cerebral pal sy, brain

in j ury or mental defi ciency .5

Speech pressure essentially stems from t he home environment since that

is where the preschool chi ld spends hi s chi l dhood most . Parental

perfecti onism or over-concern has been shown to exact environmental

pressures on children to live up to excess i vely high standard of speech

and behavior . Even the most articu late child is pressured to exceed

hi s speech or language capability . 13ut such family background i s true

of ~ tuttcrC! r 5 and non- stutterers so home rnviron111ent i s onl y one> c:;ource

of unu ~ u a l pressures on speech.

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Sometimes the personality of the child can be associated with

stuttering . He may have traits such as an excessive need for approval,

perfectionism, sensitivity or anxiety. These are also factor that may

facilitate stuttering .

Some times the chi ld may put pressure on themselves by having demanding

speech models , If a parent or older sibling with unusually rapid and

fluent speech is picked as the model to emulate , it makes it t wi ce a

hard to the early speaker .

Other factors that are not mentioned here have been extensively

researched and the correlations discovered are very interest ing. But

for discussi on of this theory we have concentrated only on those

espoused by this theorist .6

In the attempt to understand the aetiology of stuttering one must be

reminded that even non-stutterers may undergo extreme speech pressure

in the home environment. Ch ildren ' s di sfluencies are also quite normal

in their early years of speech acquisition . That i s why antic ipatory

struggle behavior can al so be observed among non- stuttering children

though not among non-stuttering adults . Thereby does this theory

suffice as a conceptual mode l of the prob l em of stuttering?

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No.tu

1

2

3

4

5

6

Oliver Bloodstein, " Stuttering as Tension and Fragmentation" in

Stuttering : A Second Symposium, ed . Jon Eisenson (New York :

Harper & Row , Inc . , 1975) pp . 3-95. The theory of anticipatory

struggl e reactions is excerpted from here and is discussed

throughou t with reference to Bloodstein ' s viewpoint.

For further details on the particu lar experiments see , W.Johnson

and J .R.Knott "Studies in the Psychology of Stuttering" in Journal

of Speech Di sorders , 1937 , 2, pp . 17-19.

Wendell John son , The Onset of Stuttering, pp. 25-26.

Thi s divi s ion can be found in Rloods tcin, p. 35 .

Bl oodste in, pp.41-42.

Other such factors can be found details in Wendell Johnson and

As sociates, The Onset of Stuttering (Minneapo l is : University of

Minnesota Press , 1959) and M.F. Be rry , Speech Disorders .

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(ii) Conflict Theory

In defining stuttering this theory presented by J .G. Sheehan

distinguishes between three critieria; speech behavior, speech anxiety

and perception of self . In trying to understand the problem of

stuttering, he felt that it was important to understand these three

categories . 7

Speech behavior consists of blackings , stickings, grimaces , foringo,

repetitions , prolongations or other rhythm breaks or interruptions in

the forward flow of speech .

Speech anxiety is represented by fear or ant icipation of blackings,

fear of inability to speak , or related symptoms prior to words or to

speaking situations .

Perception of self is defined as a self concept which includes a

picture of himself as a stutterer , speech blocker or a person lacking

normal speech fluency . This idea of self perception and expectation

can put a lot of pressure on the stutterer.

However , the stutterer is not the only one experiencing self doubt and

anxiety during moments of stutter ing . The listener 's perception of the

situation is equally demanding because he does not know what is the

right response . Should he watch or should he avert his gaze? Should

he help with the word or not? Should he recognise the di sorder or

pretend it i~ not there?

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The conflict of the listener is somewhat s imilar to the

approach-avoida nce confl ict that this theory expounds . Only t hi s time

t he stutterer ' s conflict i s not just an uncomfortable moment . It i s a

recurring problem.

The stutterer experiences two opposing urges; one to speak and the

other to hold back . Stuttering i s only a momenta ry blocking. It will

occur when the conflicting approach and avoidance tendencies reach an

equilibr ium. (See Fi g.3)8

~ c. fl Ff' r ooG h g ll wiJCAm .. e. ~ \ r Cl( r Cl ··c.; I cJ -s::

\ u

t \

~ \

~ \ J' s

"""::)

J 't -c ' ~ \ ~ \ Qi

$,ot" Ln5 f~arcJ C\-d<t J

V i:, / unc.e.

Fig.3

Jo hn son (1963) had actua lly talked about the two forces in a

co111nuni cative s ituation; the facilitory and the inhibitory, Thi s

positive and negative, the progress ing and retreating behavior was

already cla imed to be a duality which results in stut tering . However

it wa s then only a general mode l to faci litate a relationshir between

Lhc psyc hol ogic.d l and phys iologi ca l pha ses of stuttrring.9

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In presenting a conflict hypothesis which would all ow for a more direct

behavioral modification eg. avoidance reduction therapy , Sheehan also

introduces the double approach avoidance conflict model . Both the

simple approach conflict and double approach-avoidance conflict were

actua l ly two of the four basic kinds of conflict listed by Miller

(1944) . lO

The double approach-avoidance conflict is considered to be a more

comprehensive and significant contribution to the problem of

stuttering. Conflict is analysed not only as that between speaking and

not speaking but also the conflict within these tendencies.

The conflict on speaking is because there is an approach tendency for

fu l fi lling the socially demanded role of speaking . But speaking would

entail the danger of stuttering . Fea r of this danger would result in

an avoidance tendency .

The conflict on not speaking is analysed as an approac h tendency

towards silence because it is an attractive alternative to the danger

of speaking. But in situations that demand speech, not being able to

speak is also a threat to be feared. Many stutte rers i s said to show a

fear of silence and that many of their uninte lli gent symptoms is a

measure to release the block and prevent sil ence.

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3'1 u ~ ...g ~ "O -t

I Neor

J/ffr'OOuh Avo;Jor1a.

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Fear € f ;c; f~d

'\ For

Fig .4

/

/

/

/

N ear

S.fence rcqrecl Cioa I

Suffers Fr~+rof ;on Qf'1cJ Gudt.

Fig .4 illus trat es the conflict ing urges toward speech and towards

silence in the doubl e approach avoidance confli ct model . Movement

toward either feared goal (speech or s il ence } will <' li cit more

momentary fear , which increases until the goal i s reached and quilt

follows either choice.

As there is an approach and avoidance tendency for either choice the

stutterers will always view t he more distant goal as t he more

desirable. In approaching speech or si lence it becomes too feared, so

he will turn around in order to reduce fear and ins tead favour his

avoidance tendency . The situation becomes somewhat like a pendulum and

such behavi ou r i s said to be characteristi c of the stutterer .

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The conflict theory is based on quite a few assumptions eg. the

tendency to approach a goal is stronger the nearer the subject is to

it, the tendency to avoid a feared stimulus is stronger the nearer the

subject is to it, the strength of avoidance increases more rapidly with

nearness than does that of approach and etc . .. 12

The approach-avoidance conflict model is claimed to relate stutte r ing

to anxiety and avoidant behavior in a systematic , meaningful way and

also to show how anxiety leads to stuttering. It also states that

primary and secondary stutterers are victims of the same conflict. It

can also explain hesitations in normal speakers . But pPrhaps as a

formal theory, skepticism is desirable because it has not proven itself

able to explain the aetiology of stuttering, only the moment of

stuttering; though it docs do it better than the anticpatory-slruggle

theory.

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Noteti

7

8

9

10

11

12

Joseph G.Sheehan, "Conflict Theory and Avoidance - Reduction

Therapy, 11 in Stuttering : A Second Symposium, ed., Jon Eisenson

(New York : Harper & Row Publisher Inc. , 1975)

Even though the concept of conflict is not completely origina l ,

the ana lysis of the stutterer in these three categories is an

additional contributi on . The value of it in cl inical terms has

yet to be determined.

A theoretical mode l to enable the analysis of the process in which

equi librium is reached subject to the relative strengths of the

grad ients of eac h, in Sheehan , p.107 .

Wendell Johnson , ed., Stuttering in Children and Adults

(Minneapolis : University of Minnesota Press, 1963) p. 27 .

Sheehan, p. 111 lists the four bas i c kinds.

Sheehan, p. 112.

All of the more significant assumptions can be found in Sheehan ,

pp. 1114-118.

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RELATING RESEARCH TO THEORY

Instead of reviewing the research data that either Bloodstein or

Sheehan has presented as evidence for their theories, I have decided to

test their theories based on some independently made studies .

The first test is based on a study by G.Mill er Friedman. The purpose

of the study was to devise a means of quantifying stutterers

eva luations of stuttering. As both theories have explained the moment

of stuttering in terms of internal processes such as anticipation and

anxiety or approach-avo idance confl ict, u review of how stutterers

characterise their own moments of stuttering is relevent .

The subjects were 326 stuttercs and 100 non-stutterers and they ranged

in age from 11 to 53 years. They were required to answer questions in

a test . 1 (see App .a)

There were so significant differences in compari ng the hobbies of

stutterers and non-stutterers . In the data concern ing t heir foremost

wishes there were also no significant differences except that with

respect to improved speech. 68% of the stutterers said that it was

t heir most desired wish and of course non of t he non-stutterers even

thought of it.

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One relevant result was the difference of 14% for stutterers and 5% for

the non-stutterers when asked if they considered t hemselves "shy" or

11 very shy". The fact that more of the stutterers rated themse 1 ves as

shy and nearly half said they were not good mixers. Since personality

facto rs cannot account for the difference it can be concluded that

stuttering has ma de them appear shy to t hemse lves . Being shy and not

good mixers can be conven ient excuse no t to put themselves in a social

environment whi ch require them to speak . Also 11 shy 11 and not "good

mixe rs" are more acceptabl e label s for t heir reluctance t o put

t hemselves in speaking situati ons .

So far as inclination to worry was concerned sli ghtly more than ha l f

fo r both groups admitted to it bu t 34f of t he stutterers to 3f of

non-stutterers were "very much " mo re worri ed .

Whil e some of the statements made in t he test were amb i guous and more

general than advisable we ca n still see how a stuttcrer ' s perception of

self ca n be manipulated to help t herapy.

In the conflict theory , an avo idance- reducti on t herapy is suggested .

What the stutte rrers hope to avoid need to be made less fea rsome .

Based on this study the therap ist can try to build self-confidence and

encourage the engag ing of less demanding socia l roles . If stutterers

ca n be made to fee l themse lves less shy and perhaps better mixers , they

would not fear and avoid speaking .

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The same i s to be applied in the anticipatory strugg le theory .

Previous experience must be made to seem unreli able. Intense worrying

about a forthcoming word makes one ignorant about the people around

you . Hence the term 11 shy 11 or not "good mixers" .

Also the fact that stutterers consider themsel ve inadequate in social

environments imply a certain expectation of what is considered

acceptable. Since they cannot fulfill their own demands , each new

speaking situation will have greater speech pressure as their belief in

their own inadequacy intensifies .3

In another study by Jeanette Frasier which attempts to ob tain perti nent

assumptions amde by the stutterers themselves as to their disfluency ,

subjects were aga in required to answer quest ions . On ly this time the

ques tions were open-ended rather tha11 the Yes/No type .

This stutterer's personal evaluation i s important because the t heories

thus presented uses psychological processes to exp lain the phenomenon

of stuttering. By obtaining their interpretation of their situation we

can then rel ate their perceptions and fee ling to the theories .

This study examines stutterers written responses to fi ve questi ons. 4

Of t he nineteen stutterers investigated t hirteen were male and six were

female, and they ranged in age f rom th irteen to eighteen years .

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In response to questions as to what they felt was the cause of their

stuttering, eight of the subjects replied nervousness ,

self-consciousness, tenseness , 1~xcitement, or lack of self-control .

Only two replied they didn 't know what caused their stuttering . The

others were more specific; loss of speech one month preceeding a

tonsillectomy re sulted in stutte~ring when speech was regained, improper

breathing and viability to find the right words you want to say or

meeting strange people .

The first category of answer reflect an awareness of their

psycho logical profile pr ior to stutteri ng . Whil e terms like

nervousness and t enseness are vague, in the conventi onal sense t hey do

reflect some kind of nervous anticirntion and internal conflit . Terms

like lack of se lf-contro l indicate a behavior t hat is opposite to their

intent ion and desire .

Such vagueness and abstraction arc accurate in the sense that a

majority reported that t hey had tnever read up on sutttering so the

description given is as accurate as t hey ca n get. Also it is

impossib le to prove the anticipation strugg le model or the conflict

model without influencing t he results by using the terms anxiety,

anticipation , approach-avoidance tendencies etc . .. to the subject . In

desperation for an accurate descri ption , subjects would then tend to

repear the terms used .

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Other physical descriptions such as a general bodily tension , excessive

perspiration and increased rate of heart beat are just more evidence of

tension and anxiety. They could be merely a reaction to the fear of

stuttering .

Scientific observations are impossible in order to substanti ate the

statements made by the subjects. But the assumptions represented by

t hese statements does fortify some of the cl aims made by the two

theories presented earlier . Suc h as certain words are more difficult

to say than other substantiate the consistency of stimuli in the

antic ipatory strugg le theory . Tlhat stuttering is socially disapproved

but i s impossible to avoid is another conclusion that points to the

approach-a voi dunce argument . Al !>O the fact that it is more difficult

to speak to certain people and in certain situations imply a range of

factors such as speech pressure in certain perceptions of the

environment , past experience of similarly difficult situations or an

overestimation of the role demanded of stutterers in soc iety.

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Conclusion

The two studies here were picked simply because t hey were made based on

the stutterer's perspectives. The statistics that can be found in

literature on stuttering is endless and unfortunately quite irrelevant

to an expl anati on of the problem. Much has been made of the

psychol og i cal facto rs and I fee l rightly so . There i s sufficient

justification for t he stress on the catiology of stuttering. In

studying any psychological phenomenon such as stutteri ng the concern

should not just be on the deve lopment and ori gins of the problem but

also how such in forma tion can be used or manipul ated for treatment . I

cannot hope to expand as to what const i tute a suffici en t program for

t herapy as a mere student of psychol ogy but I do understand that in

dealing with people, we must see each stutte rer as dn individual with

hi s/her own persona 1 experiences to the prob l cm . 1 heory here mere ly

helps to guide one ' s perspect ive, 1nai nly the cl inician's on how to

eva 1 ua te a stutterer. For my purpose, I merely hope for a better

understanding and acceptance of a prob lem in thi s country that i s not

even acknowl edged .

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No tu

1

2

3

4

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The attitude sca le wa s actually constructed by W.Johnson . The

scale sheet can be found at the end of the chapter and is

reprinted from, "A Test of Attitude Toward Stuttering" , by

Gl adys Miller Friedman in Stuttering in Children and Adults , ed.

Wende ll Johnson, (Minneapolis: University of Minnesota Press ,

1963) pp . 317- 334 .

These results can be found in G.M. Friedman , p. 323 . See also the

reliabi l ity coeff icents .

These conclusions I have made arc mere correlations of the

theories in rel ation to the research data.

The list of questions is in Appendix G.

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Bibli ography

Berry , M. F. and J . Eisenson , Speech Disorders : Principles and Pract ices

of Theory. London : Peter Owen Ltd. , 1964 .

Chapman Myfanny E.Self Inventory : Group Therapy For Those Who Stutter .

3rd ed . Minneapolis: Burgess Publishing , 1965 .

Costello , Janis M.ed . Speech Disorders in Chi l dren Recent Advances .

California : College-Hill Press , 1984.

Eisenson, Jon ed . Stuttering A Speech Symposium. New York Harper

& Row, 1975.

---. Is Your Ch il d• s Speech Normal ? Canada Addi son-Wes 1 ey

Publishing Co. , 1977.

Fransella, Fay . Personal Change and Reconstructi on . London Academic

Press , 1972 .

Johnson, Wendell , Frederic l .Darlcy and D.C . Spriestesbach, eds.

Diagnostic Methods in Speech Pat hol ogy .

Johnson , Wendell , et a l . The Onset of Stuttering. Mi nneapoli s

University of Minnesota Press, 1959 .

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